Provider Demographics
NPI:1083902571
Name:MCCALLISTER, NONIKA DALEANN (RN)
Entity Type:Individual
Prefix:
First Name:NONIKA
Middle Name:DALEANN
Last Name:MCCALLISTER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1005 SE 214TH AVE
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-3446
Mailing Address - Country:US
Mailing Address - Phone:971-302-3354
Mailing Address - Fax:
Practice Address - Street 1:1005 SE 214TH AVE
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-3446
Practice Address - Country:US
Practice Address - Phone:971-302-3354
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-18
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN61215528163WH0200X
OR201141860RN163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health